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Gogollari A, Mitchell S, Guttormsen S. Swiss medical schools' experiences with online teaching during the COVID-19 pandemic in light of international experiences. BMC Med Educ 2024; 24:242. [PMID: 38448941 PMCID: PMC10916260 DOI: 10.1186/s12909-024-05218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND During the pandemic, all universities had to switch to digital learning and teaching (DLT), the experiences were diverse. The advantages and obstacles of DLT are well reported in research. To ensure a sustainable DLT implementation, the requirements of institutions, educators and students should be aligned. OBJECTIVE This paper aims at identifying and describing the experiences made at the Swiss medical schools after having to switch from on-site to on-line teaching; in particular, the experienced issues, requirements, and solutions were investigated and compared to international literature. METHODS We conducted a literature review to derive themes and subthemes regarding the central aspects of the transition from on-site to on-line teaching. Also, we conducted semi-structured interviews with people responsible for the medical curricula at the Swiss Medical Schools. We used a purposive sampling method and invited eleven curriculum managers at the seven Swiss Medical Schools. The interviews were conducted in English, audio-recorded and transcribed. Subsequently the data was analysed with the software NVivo. We used a qualitative, deductive, content analysis to explore faculty experiences. RESULTS Twenty-four articles met the eligibility criteria and were included for full text screening. Of the included articles, 15 reported on DLT in general and nine articles reported on DLT during the Pandemic. The thematic analysis of the interviews resulted in four overall themes, requirements, obstacles, facilitators and advantages. Curriculum managers reported that institutions were relatively unprepared for the quick transition from onsite to online at the onset of the pandemic. CONCLUSIONS Our research reports a lack of institutional structures, communication, digital competences and literacy, teaching strategies, as well as a theoretical foundation for DLT implementation. A conceptual framework for DLT adapted to the Swiss universities beyond the current situation is needed.
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Affiliation(s)
- Artemisa Gogollari
- Institute of Medical Education, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Mittelstrasse 43, 3012, Switzerland.
| | - Sharon Mitchell
- Institute of Medical Education, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Mittelstrasse 43, 3012, Switzerland
| | - Sissel Guttormsen
- Institute of Medical Education, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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Mitchell S, Sehlbach C, Franssen GHL, Janczukowicz J, Guttormsen S. Taxonomy of teaching methods and their use in health professions education: a scoping review protocol. BMJ Open 2024; 14:e077282. [PMID: 38245012 PMCID: PMC10806689 DOI: 10.1136/bmjopen-2023-077282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Applying the lens of social constructivist theory, teaching methods facilitate the process of learning and may be used differently across settings to align learning goals. Teaching methods are used across disciplines, occupations and learning settings, yet terminology, descriptions and application for use vary widely. This scoping review will identify eligible literature of reported teaching methods with documented descriptions across disciplines with a focus of how teaching methods are applied to health professions education. A literary description of a teaching method was used as a basis from which to select eligible articles based on two criteria, a specified method and delivery of that teaching by a teacher figure. METHODS AND ANALYSIS Using the extension of the Joanna Briggs Institute methodology aligned to Arksey and O'Malley's six-stage framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, this scoping review will systematically search ERIC, Embase, Web of Science and PubMed databases. The search strategy was supported by an information specialist. Eligible studies will be identified in a two-stage screening process with four researchers. To complement eligible peer-reviewed literature, we will also search out relevant grey literature including University Websites, Conference Programmes and handsearched reference lists. Data extraction will be performed using a developed data extraction tool. A narrative summary will accompany charted results and describe the results aligned to the study objectives. ETHICS AND DISSEMINATION As no intervention or patient recruitment is required for this research, ethics board approval is not required. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and where feasible reaching out to those organisations and universities with published glossaries of terms for teaching.
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Affiliation(s)
- Sharon Mitchell
- Institute for Medical Education, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Carolin Sehlbach
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Gregor H L Franssen
- Maastricht University Library, Maastricht University, Maastricht, Netherlands
| | | | - Sissel Guttormsen
- Institute for Medical Education, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Institute for Medical Education, Medical Faculty, University of Bern, Bern, Switzerland
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Mitchell S, Phaneuf JC, Astefanei SM, Guttormsen S, Wolf A, de Groot E, Sehlbach C. A Changing Landscape for Lifelong Learning in Health Globally. Journal of CME 2023; 12:2154423. [PMID: 36969486 PMCID: PMC10031767 DOI: 10.1080/21614083.2022.2154423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
On 25 July 2022, the Continuing Professional Development (CPD) Special Interest Group of the Association for Medical Education in Europe came together to open up discussions during a live webinar on 'Exploring the Evolution of CPD'. The objective was to bring together global medical educators to consider perspectives of CPD from the role of global lifelong learners, the role of educators and the role of education providers and health regulators. The landscape of CPD is evolving, and the roles of each key player must include specific actions for facilitated change. Delivering competency outcomes-based learning, fit for purpose, to lifelong learners in health will require (1) learner agency, (2) leadership from educators and (3) providers of lifelong learning to come together to improve delivery of CPD that leads to meaningful change in practice care delivery.
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Affiliation(s)
- Sharon Mitchell
- Institute of Medical Education (IML), University of Bern, Bern, Switzerland
| | - Julien-Carl Phaneuf
- School of Health Professions Education (SHE), University of Maastricht, Maastricht, The Netherlands
| | | | - Sissel Guttormsen
- Institute of Medical Education (IML), University of Bern, Bern, Switzerland
| | - Amy Wolf
- Small Is Mighty Ltd, Johannesburg, South Africa
| | | | - Carolin Sehlbach
- School of Health Professions Education (SHE), University of Maastricht, Maastricht, The Netherlands
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Wohlfarth B, Streit SR, Guttormsen S. Artificial Intelligence in Scientific Writing: A Deuteragonistic Role? Cureus 2023; 15:e45513. [PMID: 37868501 PMCID: PMC10585191 DOI: 10.7759/cureus.45513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/24/2023] Open
Abstract
In this article, we reflect on the pros and cons of artificial intelligence (AI)-augmented scientific writing for more comprehensible research towards society to gain trust for science-led policy. For this purpose, we integrated our thoughts into the Factors of Perceived Trustworthiness from Mayer, Davis, and Schoorman's Model of Trust and made propositions to define AI's role in trustful scholarly communication.
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Affiliation(s)
- Benny Wohlfarth
- Institute for Medical Education, University of Bern, Bern, CHE
| | - Samuel R Streit
- Department of Angiology, Inselspital Bern, Bern University Hospital, Bern, CHE
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Bosshard M, Schmitz FM, Guttormsen S, Nater UM, Gomez P, Berendonk C. From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial. BMC Psychol 2023; 11:153. [PMID: 37165406 PMCID: PMC10173625 DOI: 10.1186/s40359-023-01167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION ClinicalTrials.gov (NCT05037318), September 8, 2021.
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Affiliation(s)
- Michel Bosshard
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | | | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Urs Markus Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform "Stress of life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Patrick Gomez
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health, University of Lausanne, Lausanne, Switzerland
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Schurter T, Escher M, Gachoud D, Bednarski P, Hug B, Kropf R, Meng-Hentschel J, König B, Beyeler C, Guttormsen S, Huwendiek S. Essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss federal licensing examination for human medicine. GMS J Med Educ 2022; 39:Doc43. [PMID: 36310888 PMCID: PMC9585413 DOI: 10.3205/zma001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011. METHODS Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report. RESULTS The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process. CONCLUSION Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.
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Affiliation(s)
- Tina Schurter
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Monica Escher
- University of Geneva, Medical Faculty, Geneva, Switzerland
| | - David Gachoud
- University of Lausanne, Medical Faculty, Lausanne, Switzerland
| | - Piotr Bednarski
- University of Fribourg, Medical Faculty, Fribourg, Switzerland
- University of Bern, Medical Faculty, Bern, Switzerland
| | - Balthasar Hug
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Lucerne, Medical Faculty, Lucerne, Switzerland
| | - Roger Kropf
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - Juliane Meng-Hentschel
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Benjamin König
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Christine Beyeler
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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Mitchell S, Jaccard E, Schmitz FM, von Känel E, Collombet P, Cornuz J, Waeber G, Guessous I, Guttormsen S. Investigating acceptability of a training programme in precision medicine for frontline healthcare professionals: a mixed methods study. BMC Med Educ 2022; 22:556. [PMID: 35850770 PMCID: PMC9294840 DOI: 10.1186/s12909-022-03613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Precision Medicine offers tailored prevention, diagnosis, treatment and management to patients that considers genomics, lifestyle and environmental factors. If implementation of Precision Medicine is to advance, effective, focused upskilling of frontline healthcare professionals through quality continuing professional development is needed. This study reports on an evidence-based approach to needs assessment to investigate the current level of knowledge of Precision Medicine, acceptable content for training, the perceived potential of a more precision approach to patient care and motivation to participate in a training programme among pharmacists, advanced practice nurses and general practitioners. Investigating perceived needs can avoid a top-down approach and support a design that is fit for purpose to targeted professions. METHODS This study reports on 2 focus groups (n = 12) delivered in French and German with equal professional participation of the targeted professions. The research objectives were investigated in two phases. During the first phase, a literature review and expert consultations were conducted to develop a definition of PM, patient cases and content for training. In a second phase, these investigations were further explored using focus groups to investigate acceptable learning objectives, the potential of PM to relevant professions and motivation of participants. Quantitative investigations using rating scales and visual analogues were incorporated. The focus groups were audio recorded, transcribed by intelligent verbatim and translated to English. NVivo was used for data analysis and interpretation following a hybrid approach using the Framework Method and thematic analysis. The analytical framework, Implementation Science, was applied to organise and present research data. RESULTS Precision Medicine is considered a new topic area, largely unfamiliar to frontline healthcare professionals.. There was acceptance of a more precision approach to care among all participants with perceived positive implications for patients. Valuable insight was gathered on acceptable content and form for training. All participants expressed concerns on readiness within their professions which included an insufficient system infrastructure, a lack of time to attend needed training, a lack of clarity for use in practice and the time needed to build a support network. CONCLUSIONS A precision approach to patient care is on the horizon for health care professionals not only in hospital settings but also at the community level. Our results conclude that an adaptable and flexible training programme in PM is timely, contextually relevant and conducive to the needs of targeted health professions for successful implementation. A training programme in PM will require support across sectors and stakeholders, supporting insurance models, educated patients and integrated care supported by innovative technology. Implementation Science outcomes are a useful strategy towards design of an effective training programme that can have measurable impact in practice.
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Affiliation(s)
- Sharon Mitchell
- Institute of Medical Education (IML), University of Bern, 3201, Bern, Switzerland.
| | - Evrim Jaccard
- Department of Medicine, University Hospital CHUV, Lausanne, 1011, CH, Switzerland
| | | | - Elianne von Känel
- Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, CH, Switzerland
| | - Prune Collombet
- Primary Care Medicine, Faculty of Medicine, Geneva University Hospital (HUG), Geneva, 1205, CH, Switzerland
| | - Jacques Cornuz
- Faculty of Biology and Medicine, Unisanté, University of Lausanne, Lausanne, 1011, CH, Switzerland
| | - Gérard Waeber
- Department of Medicine, University Hospital CHUV, Lausanne, 1011, CH, Switzerland
| | - Idris Guessous
- Primary Care Medicine, Faculty of Medicine, Geneva University Hospital (HUG), Geneva, 1205, CH, Switzerland
| | - Sissel Guttormsen
- Institute of Medical Education (IML), University of Bern, 3201, Bern, Switzerland
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Guttormsen S, Lörwald A, Wagner F, Hennel E, Schnabel KP, Weber R, Goldhahn J, Huwendiek S. Report of the annual meeting of the Society for Medical Education in the German speaking countries, virtual from the ETH Zürich 2021. GMS J Med Educ 2022; 39:Doc15. [PMID: 35692356 PMCID: PMC9174068 DOI: 10.3205/zma001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Sissel Guttormsen
- Universität Bern, Institut für Medizinische Lehre, Bern, Switzerland
| | - Andrea Lörwald
- Universität Bern, Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Bern, Switzerland
| | - Felicitas Wagner
- Universität Bern, Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Bern, Switzerland
| | - Eva Hennel
- Universität Bern, Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Bern, Switzerland
| | - Kai P. Schnabel
- Universität Bern, Institut für Medizinische Lehre, Bern, Switzerland
| | - Rainer Weber
- Universität Zürich, Medizinische Fakultät, Dekanat, Zürich, Switzerland
| | - Jörg Goldhahn
- ETH Zürich, Departement Gesundheitswissenschaften und Technologie, Zürich, Switzerland
| | - Sören Huwendiek
- Universität Bern, Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Bern, Switzerland
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Wagner FL, Feller S, Schmitz FM, Zimmermann PG, Krings R, Guttormsen S, Huwendiek S. Usability and preference of electronic vs. paper and pencil OSCE checklists by examiners and influence of checklist type on missed ratings in the Swiss Federal Licensing Exam. GMS J Med Educ 2022; 39:Doc24. [PMID: 35692359 PMCID: PMC9174065 DOI: 10.3205/zma001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Only a few studies with small sample sizes have compared electronic Objective Structured Clinical Examination (OSCE) rating checklists with traditional paper-based OSCE rating checklists. In this study, the examiner-perceived usability and preference for type of OSCE checklist (electronic vs. paper based) were compared, and the influence of OSCE checklist type on missed ratings was determined, for the Swiss Federal Licensing Examination in clinical skills for human medicine. METHODS All examiners in the Swiss Federal Licensing Examination in clinical skills for human medicine were invited over two subsequent years to evaluate the OSCE checklist type they had worked with during the examination. This was based on a questionnaire with 14 closed questions (i.e., demographic, checklist-type experience, perceived usability, checklist type preference). Furthermore, the numbers of missed ratings for the paper-based checklist were recorded. RESULTS The data from these examiners (n=377) with experience of both OSCE checklist types were analyzed. The electronic OSCE checklist was rated significantly higher on all usability aspects (i.e., ease of use, candidate rating and error correction, clarity, distraction using the checklist, overall satisfaction), except for the speed of registering comments (no significant difference). The majority of the examiners in both years (2014: 54.5%, n=60, 2015: 89.8%, n=230) reported preference for working with the electronic OSCE checklist in the future. Missed ratings were seen for 14.2% of the paper-based OSCE checklists, which were prevented with the electronic OSCE checklists. CONCLUSIONS Electronic OSCE checklists were rated significantly more user-friendly and were preferred over paper-based OSCE checklists by a broad national sample of examiners, supporting previous results from faculty-level examinations. Furthermore, missed ratings were prevented with the electronic OSCE checklists. Overall, the use of electronic OSCE checklists is therefore advisable.
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Affiliation(s)
- Felicitas L. Wagner
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sabine Feller
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Felix M. Schmitz
- University of Bern, Institute for Medical Education, Department for Software Development, Usability Consulting and IT Infrastructure, Bern, Switzerland
| | - Philippe G. Zimmermann
- University of Bern, Institute for Medical Education, Department for Software Development, Usability Consulting and IT Infrastructure, Bern, Switzerland
| | - Rabea Krings
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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Piumatti G, Guttormsen S, Zurbuchen B, Abbiati M, Gerbase MW, Baroffio A. Trajectories of learning approaches during a full medical curriculum: impact on clinical learning outcomes. BMC Med Educ 2021; 21:370. [PMID: 34233677 PMCID: PMC8262035 DOI: 10.1186/s12909-021-02809-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND No consensus exists on whether medical students develop towards more deep (DA) or surface learning approaches (SA) during medical training and how this impacts learning outcomes. We investigated whether subgroups with different trajectories of learning approaches in a medical students' population show different long-term learning outcomes. METHODS Person-oriented growth curve analyses on a prospective cohort of 269 medical students (Mage=21years, 59 % females) traced subgroups according to their longitudinal DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in academic performance between subgroups throughout the 6-year curriculum until the national high-stakes licensing exam certifying the undergraduate medical training. RESULTS Two longitudinal trajectories emerged: surface-oriented (n = 157; 58 %), with higher and increasing levels of SA and lower and decreasing levels of DA; and deep-oriented (n = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels of DA. Post hoc analyses showed that from the beginning of clinical training, deep-oriented students diverged towards better learning outcomes in comparison with surface-oriented students. CONCLUSIONS Medical students follow different trajectories of learning approaches during a 6-year medical curriculum. Deep-oriented students are likely to achieve better clinical learning outcomes than surface-oriented students.
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Affiliation(s)
- Giovanni Piumatti
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland.
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Institute of Public Health, Faculty of BioMedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Sissel Guttormsen
- Faculty of Medicine, Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Barbara Zurbuchen
- Faculty of Medicine, Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Milena Abbiati
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Margaret W Gerbase
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Bauer D, Lahner FM, Huwendiek S, Schmitz FM, Guttormsen S. An overview of and approach to selecting appropriate patient representations in teaching and summative assessment in medical education. Swiss Med Wkly 2020; 150:w20382. [PMID: 33306811 DOI: 10.4414/smw.2020.20382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medical education has a long tradition of using various patient representations in teaching and assessment. With this literature review we aim, first, to provide an overview of the most important patient representations used to teach and assess clinical skills, considering in particular “summative exams” that have a pass or fail outcome; second, to provide arguments for choosing certain patient representations; and third, to show the advantages and limitations of different patient representations, especially simulated patients (SPs) and real patients (RPs). Typical patient representations include case narratives, anatomical models, simulators and mannequins, as well as SPs and RPs. The literature indicates that there are multiple ways of using various patient representations in teaching and that the intended didactical purpose informs the choice of representation. Early in the educational programme, even low-fidelity patient representations can be a good fit for assessment purposes if chosen to match the educational level. The use of RPs in summative, high-stakes assessments (exams with particularly important consequences for the examinee) is limited for methodological and ethical reasons. The methodological implementation of summative exams also entails specific challenges, such as ensuring measurement reliability and fairness towards the examinees. Carefully prepared, SPs can perform their roles with a sufficient degree of authenticity, making summative exams more manageable, and imposing no strain or risk on RPs. The ongoing debate concerning the use of SPs and RPs in summative assessment highlights perceived limitations of SPs in relation to RPs that are often not supported by research. Evidence shows that SPs, in combination with additional simulation modalities as needed, represent the first choice for summative clinical assessment. We also consider the strengths and limitations of this review and reflect on the applicability of our findings. We conclude that in order to select the right patient representations in clinical teaching and/or assessment, a number of perspectives must be considered: (i) the learning goals, aligned with the stage of study, (ii) the corresponding requirements of the clinical task itself (e.g., performing a phlebotomy or a communication task), (iii) the level of authenticity required and (iv) the resources needed, taking patient safety and feasibility into consideration.
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Affiliation(s)
- Daniel Bauer
- Institute for Medical Education, University of Bern, Switzerland
| | | | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Switzerland
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Huwendiek S, Jung D, Schirlo C, Huber P, Balestra G, Guttormsen S, Berendonk C. The introduction of a standardised national licensing exam as a driver of change in medical education: A qualitative study from Switzerland. Med Teach 2020; 42:1163-1170. [PMID: 32772611 DOI: 10.1080/0142159x.2020.1798911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Only a few studies have described the impacts, strengths and needs for further development of national licensing exams (NLE). To gain such insights regarding the Swiss NLE, which includes a multiple-choice and a standardised clinical skills exam, we explored the perceptions of involved experts and stakeholders. METHODS We explored participants' perceptions in four focus group discussions. The interviews were recorded, transcribed verbatim and qualitatively analysed using a thematic analysis approach. RESULTS The analysis resulted in five perceived impacts, two strengths and two needs for further developments of the NLE. Perceived impacts were (1) steering students' learning behaviour, (2) supporting teachers and assessors to align teaching to competencies, (3) elevating the importance of the Swiss Catalogue of Learning Objectives, (4) setting incentives for the further development of curricula, and (5) fostering the collaboration between the faculties of medicine. Perceived strengths were the blend of assessment formats, including their competency-based orientation, and the collaborative development approach. Perceived needs lay in the NLE's further development to sustain its fit for purpose and in incentives for people involved. CONCLUSION According to our study, this NLE had, and has, notable impacts on medical education in Switzerland. Our insights can be useful for others planning a similar undertaking.
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Affiliation(s)
- Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | | | - Christian Schirlo
- Head Structure and Development, Office Vice President Medicine, University of Zurich, Zürich, Switzerland
| | - Philippe Huber
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christoph Berendonk
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Schmitz FM, Schnabel KP, Bauer D, Woermann U, Guttormsen S. Learning how to break bad news from worked examples: Does the presentation format matter when hints are embedded? Results from randomised and blinded field trials. Patient Educ Couns 2020; 103:1850-1855. [PMID: 32303364 DOI: 10.1016/j.pec.2020.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Video-based worked examples enable medical students to successfully prepare for breaking-bad-news (BBN) encounters with simulated patients (SPs). This is especially true when examples include hints that signal important content. This paper investigates whether the beneficial effect of hints only applies to video-based worked examples or also text-based examples. METHODS One-hundred-and-forty-seven fourth-year medical students attending a BBN training participated in either of two equally scaffolded, randomised field trials. Prior to encountering SPs, the students worked through an e-learning module introducing the SPIKES protocol for delivering bad news; it contained the same worked example presented to either of four groups as text or video, with or without additional hints denoting the SPIKES steps being implemented. RESULTS Only a main effect of 'hints' was revealed, implying that students in the hints groups delivered the news to an SP significantly more appropriately than those in the without-hints groups. CONCLUSIONS Independent of their presentation format, worked examples with hints best foster students' BBN skills learning. PRACTICE IMPLICATIONS In addition to video, text-based worked examples can effectively prepare students for BBN simulations if hints are included. This offers an affordable alternative to video examples, as text examples can be generated with less effort.
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Affiliation(s)
| | | | - Daniel Bauer
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
| | - Ulrich Woermann
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
| | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
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Lahner FM, Schauber S, Lörwald AC, Kropf R, Guttormsen S, Fischer MR, Huwendiek S. Measurement precision at the cut score in medical multiple choice exams: Theory matters. Perspect Med Educ 2020; 9:220-228. [PMID: 32468274 PMCID: PMC7459012 DOI: 10.1007/s40037-020-00586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION In high-stakes assessment, the measurement precision of pass-fail decisions is of great importance. A concept for analyzing the measurement precision at the cut score is conditional reliability, which describes measurement precision for every score achieved in an exam. We compared conditional reliabilities in Classical Test Theory (CTT) and Item Response Theory (IRT) with a special focus on the cut score and potential factors influencing conditional reliability at the cut score. METHODS We analyzed 32 multiple-choice exams from three Swiss medical schools comparing conditional reliability at the cut score in IRT and CCT. Additionally, we analyzed potential influencing factors such as the range of examinees' performance, year of study, and number of items using multiple regression. RESULTS In CTT, conditional reliability was highest for very low and very high scores, whereas examinees with medium scores showed low conditional reliabilities. In IRT, the maximum conditional reliability was in the middle of the scale. Therefore, conditional reliability at the cut score was significantly higher in IRT compared with CTT. It was influenced by the range of examinees' performance and number of items. This influence was more pronounced in CTT. DISCUSSION We found that conditional reliability shows inverse distributions and conclusions regarding the measurement precision at the cut score depending on the theory used. As the use of IRT seems to be more appropriate for criterion-oriented standard setting in the framework of competency-based medical education, our findings might have practical implications for the design and quality assurance of medical education assessments.
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Affiliation(s)
- Felicitas-Maria Lahner
- Institute for Medical Education, University of Bern, Bern, Switzerland.
- Department of Health Professions, University of Applied Sciences, Bern, Switzerland.
| | - Stefan Schauber
- Centre for Educational Measurement at the University of Oslo (CEMO) and Centre for Health Sciences Education, University of Oslo, Oslo, Norway
| | | | - Roger Kropf
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Martin R Fischer
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
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Mancinetti M, Guttormsen S, Berendonk C. Cognitive load in internal medicine: What every clinical teacher should know about cognitive load theory. Eur J Intern Med 2019; 60:4-8. [PMID: 30181017 DOI: 10.1016/j.ejim.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Internal medicine is an appropriate example of specialties in which to teach learners clinical reasoning skills, decision-making, and analytical thinking, as well as evidence-based, patient-oriented medicine. During daily clinical work, general internists always encounter a multitude of situations that lend themselves to educating medical trainees in ambulatory and inpatient settings. Application of existing learning theories to teaching has been shown to optimize teaching ability and to maximize the efficiency of teaching efforts. Cognitive Load Theory explains learning according to three important aspects: the types of memory (working and long-term memory), the learning process and the forms of cognitive load that affect our learning. The aim of this paper is to show the main perspectives and implications of the Cognitive Load Theory on clinical educational practices. It is important to give the right amount of information in the most effective way to learners, thereby making this information more useful. This article presents a concise overview of the basis of the Cognitive Load Theory in its first part, and, in its second part, it exposes the practical applications of this theory with examples. This learning theory will encourage clinical teachers to reflect on how to foster learning in medical trainees in the more effective way.
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Affiliation(s)
- Marco Mancinetti
- Department of Internal Medicine, University and Hospital of Fribourg, Switzerland, Chemin des Pensionnats 2, 1752 Fribourg, Switzerland.
| | - Sissel Guttormsen
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Christoph Berendonk
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
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Schmitz FM, Schnabel KP, Bauer D, Bachmann C, Woermann U, Guttormsen S. The learning effects of different presentations of worked examples on medical students' breaking-bad-news skills: A randomized and blinded field trial. Patient Educ Couns 2018; 101:1439-1451. [PMID: 29501215 DOI: 10.1016/j.pec.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/30/2018] [Accepted: 02/21/2018] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Effective instructional approaches are needed to enable undergraduates to optimally prepare for the limited training time they receive with simulated patients (SPs). This study examines the learning effects of different presentation formats of a worked example on student SP communication. METHODS Sixty-seven fourth-year medical students attending a mandatory communication course participated in this randomized field trial. Prior to the course, they worked through an e-learning module that introduced the SPIKES protocol for delivering bad news to patients. In this module, a single worked example was presented to one group of students in a text version, to a second group in a video version, and to a third group in a video version enriched with text hints denoting the SPIKES steps. RESULTS The video-with-hints group broke bad news to SPs significantly more appropriately than either of the other groups. Although no further condition-related effects were revealed, students who learned from the text version most frequently (although non-significantly) ignored unpleasant emotions (standardised emotional cues and concerns) expressed by the SPs. CONCLUSIONS The learning effect was strongest when the video-based worked example was accompanied by hints. PRACTICE IMPLICATIONS Video-related learning approaches that embed attention-guiding hints can effectively prepare undergraduates for SP encounters.
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Affiliation(s)
| | | | - Daniel Bauer
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
| | - Cadja Bachmann
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
| | - Ulrich Woermann
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
| | - Sissel Guttormsen
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
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Lahner FM, Lörwald AC, Bauer D, Nouns ZM, Krebs R, Guttormsen S, Fischer MR, Huwendiek S. Multiple true-false items: a comparison of scoring algorithms. Adv Health Sci Educ Theory Pract 2018; 23:455-463. [PMID: 29189963 DOI: 10.1007/s10459-017-9805-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/26/2017] [Indexed: 05/25/2023]
Abstract
Multiple true-false (MTF) items are a widely used supplement to the commonly used single-best answer (Type A) multiple choice format. However, an optimal scoring algorithm for MTF items has not yet been established, as existing studies yielded conflicting results. Therefore, this study analyzes two questions: What is the optimal scoring algorithm for MTF items regarding reliability, difficulty index and item discrimination? How do the psychometric characteristics of different scoring algorithms compare to those of Type A questions used in the same exams? We used data from 37 medical exams conducted in 2015 (998 MTF and 2163 Type A items overall). Using repeated measures analyses of variance (rANOVA), we compared reliability, difficulty and item discrimination of different scoring algorithms for MTF with four answer options and Type A. Scoring algorithms for MTF were dichotomous scoring (DS) and two partial credit scoring algorithms, PS50 where examinees receive half a point if more than half of true/false ratings were marked correctly and one point if all were marked correctly, and PS1/n where examinees receive a quarter of a point for every correct true/false rating. The two partial scoring algorithms showed significantly higher reliabilities (αPS1/n = 0.75; αPS50 = 0.75; αDS = 0.70, αA = 0.72), which corresponds to fewer items needed for a reliability of 0.8 (nPS1/n = 74; nPS50 = 75; nDS = 103, nA = 87), and higher discrimination indices (rPS1/n = 0.33; rPS50 = 0.33; rDS = 0.30; rA = 0.28) than dichotomous scoring and Type A. Items scored with DS tend to be difficult (pDS = 0.50), whereas items scored with PS1/n become easy (pPS1/n = 0.82). PS50 and Type A cover the whole range, from easy to difficult items (pPS50 = 0.66; pA = 0.73). Partial credit scoring leads to better psychometric results than dichotomous scoring. PS50 covers the range from easy to difficult items better than PS1/n. Therefore, for scoring MTF, we suggest using PS50.
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Affiliation(s)
- Felicitas-Maria Lahner
- Department of Assessment and Evaluation (AAE), Institute of Medical Education, University of Bern, Konsumstr 13, 3010, Bern, Switzerland.
| | - Andrea Carolin Lörwald
- Department of Assessment and Evaluation (AAE), Institute of Medical Education, University of Bern, Konsumstr 13, 3010, Bern, Switzerland
| | - Daniel Bauer
- Department of Education and Media, Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Zineb Miriam Nouns
- Department of Assessment and Evaluation (AAE), Institute of Medical Education, University of Bern, Konsumstr 13, 3010, Bern, Switzerland
| | - René Krebs
- Department of Assessment and Evaluation (AAE), Institute of Medical Education, University of Bern, Konsumstr 13, 3010, Bern, Switzerland
| | - Sissel Guttormsen
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Martin R Fischer
- Institute for Medical Education, University Hospital, LMU, Munich, Germany
| | - Sören Huwendiek
- Department of Assessment and Evaluation (AAE), Institute of Medical Education, University of Bern, Konsumstr 13, 3010, Bern, Switzerland
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Schmitz FM, Schnabel KP, Stricker D, Fischer MR, Guttormsen S. Learning communication from erroneous video-based examples: A double-blind randomised controlled trial. Patient Educ Couns 2017; 100:1203-1212. [PMID: 28179074 DOI: 10.1016/j.pec.2017.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/18/2017] [Accepted: 01/24/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Appropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills. METHODS First-year nursing students (N=36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example's correctness) and elaborated feedback (the true explanation). RESULTS Participants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group. CONCLUSION The worked example effect was successfully adapted for learning in the provider-patient communication domain. PRACTICE IMPLICATIONS Implementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.
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Affiliation(s)
| | | | - Daniel Stricker
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
| | - Martin Rudolf Fischer
- Institute for Medical Education, University Hospital, LMU Munich, 80336 Munich, Germany.
| | - Sissel Guttormsen
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
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Guttormsen S, Bauer D, Breckwoldt J, Huwendiek S, Schnabel K, Schirlo C. GMA Annual Conference 2016 in Bern - Conference Report. GMS J Med Educ 2017; 34:Doc2. [PMID: 28293669 PMCID: PMC5327654 DOI: 10.3205/zma001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | - Daniel Bauer
- Universität Bern, Institut für Medizinische Lehre, Bern, Schweiz
| | - Jan Breckwoldt
- Universität Zürich, Medizinische Fakultät, Koordinator Studiendekanat, Zürich, Schweiz
| | - Sören Huwendiek
- Universität Bern, Institut für Medizinische Lehre, Bern, Schweiz
| | - Kai Schnabel
- Universität Bern, Institut für Medizinische Lehre, Bern, Schweiz
| | - Christian Schirlo
- Universität Zürich, Med. Fakultät, Dekanat, Stabsleiter, Zürich, Schweiz
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20
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Woermann U, Weltsch L, Kunz A, Stricker D, Guttormsen S. Attitude towards and Readiness for Interprofessional Education in Medical and Nursing Students of Bern. GMS J Med Educ 2016; 33:Doc73. [PMID: 27990469 PMCID: PMC5135421 DOI: 10.3205/zma001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 04/11/2016] [Accepted: 08/16/2016] [Indexed: 05/30/2023]
Abstract
Objectives: Interprofessional collaboration is becoming increasingly important in health care for various reasons. Interprofessional Education (IPE) can provide a basis for this. The aim of our study was to find out how medical (MS) and nursing students (NS) think about their own and other professions, what they know about each other, how strong their willingness to embrace IPE is, and what forms of IPE they deem useful. Methodology: Seven IPE experts rated the two measuring instruments, Readiness for Interprofessional Learning Scale RIPLS, and Interdisciplinary Education Perception Scale IEPS in terms of relevance of the items, and the quality of translation into German. Nine RIPLS items and 13 IEPS items were considered content-valid. All MS of the University of Bern and NS of the two Bernese educational institutions for nursing were invited to the online survey in the fall of 2014 by email. Results: 498 (254 MS, 244 NS) of the 2374 invited students completely filled in the questionnaire (21%). The results of the reduced RIPLS allowed no conclusive statements. When assessing their own occupational group in the IEPS, the MS attributed "competence and autonomy" to themselves significantly more frequently, while to the NS, the same was true for the item, "actual cooperation". MS know significantly less about the training of other health professionals. NS show a significantly higher willingness to embrace IPE. Teaching ethics, communication, team training, and clinical skills are deemed suitable for IPE by both groups. From the comments it appears that in both groups a majority welcomes IPE; however, the various arguments had different prevalence in both groups. Both groups fear that IPE leads to heightened stress during the study. A subgroup of MS fears a lowering of academic level. Conclusion: The results of this survey of Bernese MS and NS concerning IPE provide important information for the planning and implementation of IPE. Important steps in the introduction of IPE will be a clear justification and the definition of its objectives. These must be explicitly communicated to all students.
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Affiliation(s)
- Ulrich Woermann
- University of Bern, Institute for Medical Education IML, Education and Media Unit AUM, Bern, Switzerland
| | | | - Alexandra Kunz
- University of Bern, Institute for Psychology, Bern, Switzerland
| | - Daniel Stricker
- University of Bern, Institute for Medical Education IML, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education IML, Bern, Switzerland
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21
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Berendonk C, Schirlo C, Balestra G, Bonvin R, Feller S, Huber P, Jünger E, Monti M, Schnabel K, Beyeler C, Guttormsen S, Huwendiek S. The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group. GMS Z Med Ausbild 2015; 32:Doc40. [PMID: 26483853 PMCID: PMC4606485 DOI: 10.3205/zma000982] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 10/30/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.
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Affiliation(s)
- Christoph Berendonk
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | | | | | - Raphael Bonvin
- University of Lausanne, Medical Faculty, Lausanne, Switzerland
| | - Sabine Feller
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Philippe Huber
- University of Geneve, Medical Faculty, Geneve, Switzerland
| | - Ernst Jünger
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - Matteo Monti
- University of Lausanne, Medical Faculty, Lausanne, Switzerland
| | - Kai Schnabel
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Christine Beyeler
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Medical Faculty, Institute of Medical Education, Bern, Switzerland
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Zimmermann P, Guttormsen S, Danuser B, Gomez P. Affective Computing—A Rationale for Measuring Mood With Mouse and Keyboard. International Journal of Occupational Safety and Ergonomics 2015; 9:539-51. [PMID: 14675525 DOI: 10.1080/10803548.2003.11076589] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emotions are an increasingly important factor in Human-Computer Interaction (HCI). Up to the present, emotion recognition in HCI implies the use of explicit or intrusive methods, for example, video cameras or physiological measurements. We are developing and evaluating a method for the measurement of affective states through motor-behavioral parameters from standard input devices (mouse and keyboard).
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Guttormsen S, Beyeler C, Bonvin R, Feller S, Schirlo C, Schnabel K, Schurter T, Berendonk C. The new licencing examination for human medicine: from concept to implementation. Swiss Med Wkly 2013; 143:w13897. [PMID: 24301323 DOI: 10.4414/smw.2013.13897] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A new Swiss federal licencing examination for human medicine (FLE) was developed and released in 2011. This paper describes the process from concept design to the first results obtained on implementation of the new examination. The development process was based on the Federal Act on University Medical Professions and involved all national stakeholders in this venture. During this process questions relating to the assessment aims, the assessment formats, the assessment dimensions, the examination content and necessary trade-offs were clarified. The aims were to create a feasible, fair, valid and psychometrically sound examination in accordance with international standards, thereby indicating the expected knowledge and skills level at the end of undergraduate medical education. Finally, a centrally managed and locally administered examination comprising a written multiple-choice element and a practical “clinical skills” test in the objective structured clinical examination (OSCE) format was developed. The first two administrations of the new FLE show that the examination concept could be implemented as intended. The anticipated psychometric indices were achieved and the results support the validity of the examination. Possible changes to the format or content in the future are discussed.
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Abstract
To investigate a possible genetic cause underlying the clinical association between multiple sclerosis (MS) and affective disorder, we studied 56 patients with MS for psychiatric and genetic (family history, sex, and HLA-DR) characteristics. The 2:1 ratio of females to males expected for patients with MS was observed in this sample (40:16), but the excess of females occurred entirely among the 31 MS patients with major affective disorder (27 females and four males). Bipolar probands with MS had significantly more relatives with affective disorder or MS than did unipolar probands with MS. The HLA-DR antigen frequencies in patients with MS categorized by type and family history of affective disorder suggest that it may be possible to validate such clustering of patients. We concluded that sex and other genetic factors are related to the affective symptoms in MS and emphasize the importance of psychiatric evaluation of these patients.
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Affiliation(s)
- R B Schiffer
- Department of Psychiatry, University of Rochester Medical Center, NY 14642
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Stancer HC, Mellor C, Weitkamp LR, Jorna T, Flood C, Persad E, Jain SC, Guttormsen S. The relationship of HLA to depression and manic depression. I. The Newfoundland follow-up. Can J Psychiatry 1987; 32:768-72. [PMID: 3481287 DOI: 10.1177/070674378703200907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This report constitutes the Newfoundland component of a large scale replication study to assess the relationship of HLA to affective disorders; the Ontario component will be published subsequently. In a collaborative study between the University of Toronto, Memorial University and the University of Rochester, first degree family members of Probands with major affective disorder in Newfoundland were assessed for the lifetime presence of psychiatric disorder; their blood was also typed for Human Leucocyte Antigens (HLA). Because of the high rate of refusal to participate, only 10 Newfoundland families could be assessed completely. While this number of families is too small to evaluate the role of HLA as a marker of susceptibility to affective disorder, the results will be added to those of the larger Ontario component. Some problems of conducting research in communities similar to those found in Newfoundland are briefly discussed in the context of characteristics of the Probands in the study group as compared with those of subjects who refused entry into the study.
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Affiliation(s)
- H C Stancer
- Department of Psychiatry, University of Toronto, Ontario
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Abstract
Two hundred sixty families, in which at least one family member had insulin-dependent (type I) diabetes mellitus (IDDM), were typed for HLA antigens and the Gm and Km allotypes. Frequencies of Gm and Km allotypes in the diabetic subjects were compared with family controls (oldest nondiabetic sibling within a family). There were no significant differences between patients and controls for either Gm or Km allotype frequencies considered individually. When the log-linear model was used to analyze subjects and sibling controls, three significant findings emerged. First, there was a significant HLA-Gm interaction, indicating nonrandom segregation of HLA antigens with Gm allotypes, regardless of disease status. Second, there was, as expected, a significant HLA-IDDM interaction, indicating that HLA type is nonrandom with respect to IDDM status. Third, there was a significant HLA-sex-Gm-IDDM interaction, indicating that combinations of HLA antigens, Gm allotypes, and sex may play an important role in defining risk for IDDM. Thus, Gm and sex interacting with HLA may reflect the influence of an unlinked modifier previously hypothesized for IDDM pathogenesis.
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Abstract
Five kindreds with multiple individuals manifesting Tourette syndrome (TS) or related abnormal movements were evaluated for linkage between TS and HLA-A, B, C and DR antigens. Families were selected to have a constellation of affected individuals which gave the appearance of transmission of a major susceptibility gene. All kindreds had at least two clearly affected first or second degree relatives. Although developmental neurobehavioral disorders are candidates for showing a relationship to specific tissue antigens, we found no evidence for a close linkage between a gene locus determining susceptibility to TS and the HLA loci.
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Weitkamp LR, Nee L, Keats B, Polinsky RJ, Guttormsen S. Alzheimer disease: evidence for susceptibility loci on chromosomes 6 and 14. Am J Hum Genet 1983; 35:443-53. [PMID: 6859040 PMCID: PMC1685639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We report the transmission of HLA haplotypes and Gm allotypes in 97 members of a single kindred containing 257 individuals, 45 of whom were determined by clinical examination, autopsy, or historical data to have had Alzheimer disease (AD). Extensive inbreeding suggests that more than one gene may contribute to susceptibility to AD in this family, despite the apparent vertical transmission of illness. The distribution of HLA haplotypes and of Gm allotypes to affected and unaffected siblings is consistent with the possibility that genes in the HLA region of chromosome 6 and perhaps also in the Gm region of chromosome 14 are determinants of susceptibility. Further studies are needed to investigate whether susceptibility to AD may result from an interaction between (immune response?) genes on these two chromosomes.
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Abstract
To determine whether HLA-linked genes on chromosome 6 influence susceptibility to depressive disorders, we tested hypotheses concerning the distribution of HLA haplotypes among specific constellations of affected and unaffected family members. HLA haplotype identity among pairs of affected siblings in families with two affected siblings and among pairs of older unaffected siblings in families with one or two affected siblings was increased over random expectation (P less than 0.005). There was no increase in HLA haplotype identity among affected siblings in sibships with more than two affected members. When parents had a relative difference in estimated load of genes for susceptibility, HLA haplotypes were randomly transmitted to unaffected or affected children from the affected, "high-load" parent, but not from the unaffected, "low-load" parent (P less than 0.001). These results locate a gene contributing to susceptibility to depressive illness on chromosome 6 and provide a second example of the value of the hypotheses in defining the genetic bases of nonmendelian, familial diseases.
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Weitkamp LR, Cox D, Guttormsen S, Johnston E, Hempfling S. Allelic specific heterogeneity in the Pi:Gm linkage group. Cytogenet Cell Genet 1978; 22:647-50. [PMID: 313312 DOI: 10.1159/000131044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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